Human Pathology: Case Reports最新文献

Background

Malignant myoepithelioma (MMB) of the breast is an extremely rare and aggressive malignant tumor. The biological behavior of such malignancy and treatment outcomes of patients has not been clearly determined.

Hypothesis

MMB is morphologically difficult to be distinguished from benign spindle cell proliferations. Identification and further research on the genesis of these tumors could help to discover new molecular targets for its management.

Case report

We herein describe the pathological and immunohistochemical characteristics of a case of MMB in a 51 year-old woman to add to the previous data about biological behavior and management strategy of such a rare aggressive entity.

We have confirmed the diagnosis of our case using immunohistochemisrty because malignant cells revealed diffuse expression of P63, SMA and S-100 in addition to high Ki-67 labeling index.

Conclusions

MMB is extremely rare entity which showed be suspected during differential diagnosis of any malignant spindle cell tumor of the breast.

Small bowel obstruction (SBO) is a commonly encountered medical condition, typically a result of extrinsic causes, including post-operative adhesions. Less frequently, intrinsic and intraluminal factors may cause obstruction. Barium sulfate is a widely used contrast agent for radiography of suspected SBO, though it is rarely encountered in histologic sections and is an uncommon cause of SBO. Here, we present a case of a patient with several risk factors for SBO who received routine diagnostic imaging. Surgical resection revealed gross adhesions and histology showed intraluminal foreign material, determined to be barium sulfate by scanning electron microscopy with energy dispersive x-ray spectroscopy.

Uterine cervical cancer can invade the urinary bladder at an advanced stage. Distinguishing between primary urothelial carcinoma and secondary carcinoma involving the bladder is extremely important because these two clinical settings have completely different management and prognosis. It can be very challenging for pathologists to determine the tumor origin, since the carcinomas in bladder and cervix have overlapping histological features and immunohistochemical profiles. Here we report a case of cervical carcinoma involving the urinary bladder in a woman with a remote history of cervical carcinoma. The diagnosis was confirmed by the aid of molecular detection of high-risk human papillomavirus 16/18 (HPV16/18).

Langerhans cell histiocytosis (LCH) is a rare disease characterized by unifocal, or multifocal unisystem, or disseminated/multisystem disease that commonly involves the bone, skin and lung. LCH involvement of the gastrointestinal tract (GI) in adults is uncommon and it rarely involves colon polyps with only few case reports in the literature. In this report, we present a case of an adult female who was found to have a cecal polyp on a routine screening colonoscopy. The histopathological examination and immunohistochemical studies confirmed the diagnosis of LCH. We also review the literature of adults LCH manifested in GI mostly colonic polyps.

Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) is a rare variant and a distinct subtype of clear cell renal cell tumors that has a favorable outcome. Most of the cases present with a low pathologic stage at diagnosis (T1 or T2). It is unusual for this tumor to extend into the perinephric adipose tissue, renal sinus fat or renal vein. There are very few cases reported in the literature to have a higher pathologic stage (pT3 and above) at diagnosis. Here, we report a case of MCRNLMP with unusual rare finding in which the tumor has extended into the surrounding perinephric adipose tissue.

Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSLGT) is an extremely rare mesenchymal tumor arising from the gastrointestinal tract. We report a case of CCSLGT with two fusion transcripts of EWSR1-ATF1. A 60-year-old female received ileectomy because of repeated ileus history. A 30-mm submucosal tumor with mucosal ulceration was detected in the ileum. Histologically, sarcomatous tumor comprised relatively monomorphic tumor cells arranged in sheets or nests and several multinucleated osteoclast-like giant cells. The main tumor cells contain small round nuclei with prominent nucleoli and abundant clear cytoplasm. Immunohistochemistry, the tumor cells expressed S-100 protein diffusely and focally expressed CAM5.2, EMA, and CD56. They did not express HMB-45, c-kit, CD34, desmin, and α-SMA. FISH analysis revealed EWSR1 split signal in the tumor cells. Reverse transcription polymerase chain reaction (RT-PCR) revealed 2 types of EWSR1-ATF1 transcripts, including EWSR1 exon 7-ATF1 exon 5 and EWSR1 exon 6-ATF1 exon 5. EWSR1-CREB1 was not detected. We finally diagnosed CCSLGT as well as identified two types of fusion transcript of EWSR1-ATF1.

We report a case of granulomatosis with polyangiitis (GPA) (Wegner's granulomatosis) who presented with multiple mass lesions in kidneys and lung lobes, as well as neck soft tissue, mimicking malignancies. This 71-year-old woman initially presented with sudden right foot drop, left calf pain and right eye vision loss. She was treated with corticosteroid for the diagnosis of possible temporal arteritis. Months after steroid was tapered to 2 mg per day, she developed increasing fatigue, weight loss, and shortness of breath. CT scan showed lung mass lesions in left upper lobe (3.8 × 2.4 cm), right mid lung with pleural extension (3.4 × 3.3 cm), and right lower lobe (1.1 × 1.0 cm); right neck (3.3 × 2.6 cm), right kidney (2.3 × 1.8 cm) and left kidney (2.0 × 1.6 cm). Right quadriceps muscle biopsy shows focal granulomatous inflammation. Lung biopsy showed necrotizing and poorly formed granulomatous inflammation. Biopsies of kidney mass lesions showed necrotizing and non-necrotizing granulomatous inflammation. No crescentic or necrotizing glomerular lesions were observed in the total 40 sampled glomeruli. No malignancy was identified in any of the biopsies. Her c-ANCA was found to be positive and PR3-ANCA antibody was 6.88 U/ml (normal 0–0.90 U/ml). She was diagnosed with granulomatosis with polyangiitis and treated with high dose corticosteroid and rituximab. Eight months later, follow-up showed resolved mass lesions by chest X-ray and CT and stable renal function. The case highlights the atypical clinical presentation of vasculitis and the significance of considering this possibility in differential diagnosis when confronting mass lesions present in multiple organ systems. Biopsy is critical for the correct diagnosis to initiate timely and appropriate treatment, and also important to avoid unnecessary surgical resection.